血管内超声虚拟组织学成像评价氟伐他汀对冠状动脉斑块退缩及其成分的影响

Effect of fluvastatin on recession of coronary atherosclerotic plaque and its composition:Evaluation by intravascular ultrasound virtual histology

背景:近年来有很多关于抗动脉粥样硬化的大规模临床研究,其中应用血管内超声评价他汀类药物疗效的临床研究最值得关注,至于冠状动脉斑块成分的变化未见报道。目的:应用血管内超声传统灰阶成像及虚拟组织学成像,评价氟发他汀对冠状动脉斑块退缩及其成分的影响。方法:纳入22例临床初诊为冠状动脉粥样硬化性心脏病的患者接受冠状动脉造影检查,至少有1支主要冠脉分支经定量冠状动脉造影目测狭窄程度为20%～50%,将其选做目标血管。造影后对目标血管行血管内超声检查,记录灰阶及虚拟组织学图像。所有患者在检查结束后予以80mg氟伐他汀治疗12个月。比较80mg氟伐他汀调脂治疗前后低密度脂蛋白胆固醇以及总胆固醇浓度变化,通过血管内超声灰阶成像及虚拟组织学成像分析斑块体积及成分变化。结果与结论:冠状动脉轻度病变患者通过80mg氟伐他汀治疗12个月后,可以显著增加钙化成分比例,同时显著减少坏死核心成分比例以及纤维脂质成分比例,起到积极稳定斑块的作用。但是患者在治疗后斑块体积增加而管腔体积减小,并没有明显逆转斑块进展。

BACKGROUND：Recent years,antiatherosclerotic clinical studies have been conducted,and statins effect has been evaluated by intravascular unltrasound （IVUS）. Very little is known about changed in coronary atherosclerotic plaque. OBJECTIVE：To evaluate the effects of medium dosage fluvastatin on coronary atherosclerotic plaque and its composition by gray-scale IVUS and virtual histology-IVUS analysis. METHODS：A total of 22 patients who had been preliminarily clinically diagnosed as coronary heart disease were performed coronary angiography. These selected patients should have at least one major coronary branch whose stenosis extent was 20%-50% by coronary angiography examination with eye measurement. The gray scale IVUS and virtual histology IVUS after selecting the stenosis arteria coronary as target vessel were recorded and the target blood vessel was examined by IVUS. All selected patients were treated with 80 mg fluvastatin for 12 months after the examination. The low density lipoprotein cholesterol and total cholesterol levels of patients before and after the treatment were compared. Meanwhile the plaque volume and composition variation using IVUS were also analyzed. RESULTS AND CONCLUSION：After 12 months of 80 mg fluvastatin,the proportion of dense calcium was significantly increased,and the proportion of necrotic core was decreased,which stabilized plaque. However,the volume of plaque was increased but lumens decreased,not reversing plaque progression.